Healthcare Provider Details

I. General information

NPI: 1255328142
Provider Name (Legal Business Name): PIYUSH K. RAJURKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W LAYTON AVE SUITE 110
MILWAUKEE WI
53221-5420
US

IV. Provider business mailing address

6020 S PACKARD AVE
CUDAHY WI
53110-3028
US

V. Phone/Fax

Practice location:
  • Phone: 414-281-0963
  • Fax: 414-294-4396
Mailing address:
  • Phone: 414-294-4660
  • Fax: 414-294-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number44292-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: